LGBTQ+ People Face A Serious Problem In Healthcare. This Startup Aims To Close The Gap.

"The healthcare industry has operated on the assumption that it's ‘one-size-fits-all,’ and it's usually a heteronormative model ... "

When the 2016 presidential election happened, many people found themselves drawn to political resistance because they wanted to fight against something. Co-founders of Lighthouse — a New York-based digital resource for LGBTQ+-friendly healthcare and wellness providers — Nick Fager and Sahir Iqbal found themselves returning to a business idea to fight for something: LGBTQ+ equality in healthcare.

"We realized that this was a real need for our community," Fager told A Plus, noting the duo's worries that access to healthcare, and discrimination in healthcare, was going to "get worse" for the LGBTQ+ community over the course of the Trump administration. "So that's when we really went into high gear, and we realized that we were probably the team to do it."

As an LGBTQ+-specialized therapist, Fager had gained a following in the community due to his experience and knack for matching people with therapists, doctors, and specialists who could fulfill their specific healthcare needs.

While he was happy to help those he knew personally, Fager and Iqbal wanted to create a resource that could provide this same service to as many members of the LGBTQ+ community as possible."He [Iqbal] was the one who said 'OK, I think we can do this,' and wrote out a road map for us," Fager recalled. That's when they started calling other therapists and doctors, inviting them to sign on to Lighthouse. "Generally, the response was very positive, and people were ready to jump on and make profiles and help us grow the business," he said.

"Healthcare can be more specialized and geared towards specific communities — and should be," Fager said. "... The healthcare industry has operated on the assumption that it's 'one-size-fits-all,' and it's usually a heteronormative model that gets spread out to everybody. But it's not meeting the needs of certain communities, including mine." He believes the more companies, such as Lighthouse, that can offer people care based on their specific needs, the better.

Even as the business has grown, it has stayed true to its mission of filling the gap for people looking for LGBTQ+-specific healthcare with a rigorous vetting process. To become listed on Lighthouse, healthcare providers fill out an application explaining their experience with the LGBTQ+ community, including any trainings, certifications, and jobs they've had that were LGBTQ+ specific. For example, when providing care to the transgender community, knowledge of basic care, such as hormone therapy, is important. "Also, if they want to medically transition, leading them through the medical transitioning process is really nuanced and obviously takes a lot of specialization," Fager further explained.

In serving the gay community, knowledge of PrEP and PEP, two drugs that prevent HIV, is also paramount. "That could really help someone not be diagnosed with HIV," he added. "If their doctor is knowledgeable and gets them on PrEP, suddenly their chance of getting HIV goes down by a ton." In terms of mental health, Fager's specialization, "There are so many specific issues with this community… obviously internalized transphobia [and] internalized homophobia... they become voices in our own heads, and we use them to beat up ourselves. So that's really important in therapy — to be able to unearth those voices and start to challenge them and really feel more secure in your body."

Once the application is submitted, the entire Lighthouse team reviews it. "Then, we reach out, and we have a phone call where we just go through basic questions," Fager said. "If you're a doctor, are you prescribing things that our community needs? Do you have a certain level of knowledge about the community's needs? ... If you're a therapist, do you have experience with the specific issues that our community deals with such as internalized homophobia or internalized transphobia? How might you deal with those issues in session?" Fager and his team undergo this thorough process because he doesn't want Lighthouse to become another Psychology Today or ZocDoc.

"On sites such as Psychology Today, you can just check a box that says that you see, for example, the gay community. But oftentimes, that just means that people are just sort of open to gay people," he noted. "... But there's really a lot of nuance to seeing someone in the queer community so we just want to make sure that there's some level of experience, some level of passion or commitment, and also just a basic knowledge of the community."

Still, Fager is quick to say it "doesn't take a crazy amount of training" to become an acceptable provider for Lighthouse. "It just takes a level of commitment to treating this community and recognizing that there are some unique needs and … being willing to do your own work around gender, around sexual orientation. What are the biases that you hold within yourself, and how might that be affecting the way that you're showing up in therapy or in the doctor's office?"

Helping Lighthouse users find medical professionals they can trust is key because more than 50 percent of LGBTQ+ people "experience some form of discrimination in healthcare settings at some point in their lives," according to the Lighthouse website. Those who do are three times more likely to postpone follow-up care. "Being gay, for example, was labeled as a 'disorder' by the medical community and the mental health community up until 1973, so there's a level of distrust there," Fager said. "... So people don't really know where to turn for an LGBTQ- affirming provider. I mean, you can do a search on Google, but it's just very limited. You don't know who to trust so generally when an LGBTQ+ person walks into a doctor's office or a therapist's office, there's usually a real level of hesitance." According to Fager, many LGBTQ+ individuals think to themselves, 'I don't know if I can bring my full self into this room,' which may explain why 43 percent of adults ages 45-70 don't disclose their sexual orientation to their healthcare provider.

For transgender people, the distrust in the medical community is often greater, as one in five trans patients have been denied healthcare because of their gender identity. "We hear so many negative experiences about people walking into offices where they just don't feel validated, and they don't feel safe," Fager added. "So [with] what we're doing at Lighthouse, we just want to make it incredibly simple and easy for queer people to find providers that are close by ... that they know they can walk into the office and bring their whole self into the room."

That's why Lighthouse, while a website, isn't just a website. Though it mainly operates as a directory, offering as much knowledge as possible on each healthcare professional's profile, the company recently gave users the ability to leave reviews on profiles, as well.

Lighthouse is currently only available to the New York LGBTQ+ community, though the company plans to expand to other LGBTQ+ communities in "major queer cities" where demand for their service is already high, such as Chicago, Los Angeles, and San Francisco. They also aim to serve LGBTQ folks in areas where there is little to no demand for their services for that exact reason. "The original goal when we first launched the company — we imagined a queer kid in Albany not being able to find any resources around him," Fager said. "... Obviously, we can't meet that need right now; we don't have the resources to meet that need right now, but our future goal is to create a platform where you don't necessarily have to be physically in a space in order to receive care." Ultimately, he and Iqbal hope to turn Lighthouse into a telehealth platform where a LGBTQ+ individual who doesn't live in a major queer city can still see a queer-specialized doctor in said city.

Besides making LGBTQ+-affirming medical services accessible, Lighthouse is also determined to make them affordable. As the Affordable Care Act has also been under attack throughout the first two years of the Trump Administration, paying for healthcare can be another obstacle plaguing LGBTQ+ people on top of simply finding it. Lighthouse's features allow users to filter providers by the insurance they accept and tries to sign on providers and organizations who accept a wide variety of insurances as often as they can."For example, HousingWorks is a large organization that's LGBTQ-focused, and they just signed on a couple months [ago]," Fager said. "They have 25 providers in NYC and they accept every type of insurance. And if you don't have insurance, they still will bring you in and figure out a payment plan that works."

While proper healthcare is essential, its importance is too often forgotten. "Above all, our community needs to make sure that they're taking care of themselves, no matter what is going on in your life, no matter if you're being an activist," Fager concluded. "... And that's really what we're trying to do, we're trying to help people just stay healthy and do the work on themselves, so that they can become fully embodied and powerful queer people." Like its moniker, Lighthouse aims to show those who may have gotten lost in the healthcare industry, the way to safety.